Apparatus and methods for performing enhanced visually directed procedures under low ambient light conditions

ABSTRACT

A system, method, and apparatus for performing enhanced visually directed procedures under low ambient light conditions are disclosed. An example method includes acquiring at least one real-time high resolution video signal representing at least one view of an eye in at least one wavelength of light outside of the wavelengths of visible light. The example method also includes converting the at least one view corresponding to the at least one real-time high resolution video signal at the at least one wavelength of light outside of the wavelengths of visible light into at least one wavelength of visible light. The at least one real-time high resolution video signal is acquired after light conditions are low enough such that a pupil of the eye does not constrict substantially from its maximum pupillary diameter.

PRIORITY CLAIM

This application claims priority to and the benefit as a divisionalapplication of U.S. patent application Ser. No. 12/417,115, filed Apr.2, 2009, entitled, “Apparatus and Methods for Performing EnhancedVisually Directed Procedures Under Low Ambient Light Conditions”, whichclaims priority to and the benefit of U.S. Provisional Application No.61/042,606, filed on Apr. 4, 2008, the entire contents of which areherein incorporated by reference.

TECHNICAL FIELD

The present disclosure generally relates to apparatus and associatedmethods for performing enhanced visually directed procedures under lowambient light conditions on target objects including surgical procedureson structures and tissues within the body, particularly proceduresrelated to the measurement and treatment of ocular conditions.

BACKGROUND

Throughout history it has been axiomatic to those of ordinary skill inthe art that in order to perform delicate or meticulous processes andprocedures with enhanced levels of control and with improved performanceand outcomes the operators, technicians, surgeons, or other performersof the procedures must have good visual control of the various steps anddetails of the respective processes. Typically, the best way to improvevisual control of a process is to increase the amount of visible lightavailable in the workspace to brightly illuminate the target object orworking area with shadow-free white light. One need only look at thehigh wattage lighting of a contemporary precision assembly line or atthe bright lights of an operating room or dentist's office to appreciatehow important good lighting is to the precise visual control and to thesuccessful outcome of a delicate or precision procedure.

More recently, magnification and microscopy have been incorporated intometiculous testing and assembly processes and into similarly meticulousoperating theater procedures to further improve the ability of theprocess operators to see what they are working on and to allow them tobetter visually control each step of the process. For example, ocularsurgical procedures are now commonly performed under stereomicroscopesthat enable the ocular surgeons to view the minute details and responsesof various tissues within a patient's eye to the delicate steps of theprocedures involved. In addition to the bright ambient room lighting ofthe operating room or surgical theater, stereomicroscopes can includetheir own internal sources of visible light to further illuminate thetarget tissues under the microscopic control of the operating surgeon.

Even more recently, electronic imaging has been incorporated intovarious processing and medical techniques to free the operators andsurgeons from the awkward tedium of peering into the fixed eyepieces ofconventional stereomicroscopes. Digital signal processing of suchelectronic images can provide an additional degree of visual acuity thatcan facilitate the performance of a meticulous process such as eyesurgery. The present inventors recently provided a three dimensionalhigh definition visual display platform that can take the images from aconventional stereomicroscope and present them to an operator or surgeonon a conveniently located screen. Moreover, the digital threedimensional images can be electronically processed to increasemagnification or to improve signal quality and content.

However, there are circumstances where bright visible lighting canactually be detrimental to the performance of a meticulous process. Forexample, bright visible lighting can have negative effects which anoperator such as a surgeon must endure. Hot operating room lighting cancause discomfort to a surgeon as well as to the patient. In somecircumstances visors may need to be worn to reduce glare from the brightlights that must be in close proximity to the process target on anassembly line. Bright visible lighting also can take up room and floorspace within an assembly line or operating theatre, further complicatingthe processes being performed. Reducing the lighting to improve operatorcomfort reduces the ability of the operators to see and visually controlthe processes.

Additionally, there are processes and procedures where bright visiblelighting itself is detrimental to the outcome of the process. Aphotographic darkroom is an example of an environment where brightlighting, however useful to operator control, can be disastrous to theoutcome of the process. Similar problems have been reported in ocularsurgery such as cataract removal where bright lights of varying colorsand wavelengths utilized in the surgeries have been found to bedetrimental to the response of retinal tissue within the eye and mayeven have toxic effects on eye tissues.

Similarly, many types of modern eye surgery utilize lasers or otherinstruments to fuse or excise ocular tissues in order to correct medicalconditions through processes such as fusing detached retinas tounderlying tissues, sealing leaking retinal vasculature, removing opaqueposterior capsule tissues from in front of the retina, or resculptingthe shape and optical performance of a patient's cornea to correctdistorted vision. To best accomplish these and other procedures theocular surgeon would prefer to have the greatest possible visualizationand resultant control of the meticulous process. However, bright ambientlighting or bright microscope lighting has exactly the opposite resultbecause the patient's pupil constricts as a natural response to brightvisible light and restricts or eliminates access to the target oculartissues within the eye. Thus, prior to the present invention, an ocularsurgeon had to sacrifice open pupillary access to internal eye tissuesin exchange for illuminating those tissues with sufficient light to makethem visible to operate on.

An acute example of a circumstance where bright visible lighting isactually a potential limitation to a successful result is the visioncorrection procedure known as laser-assisted in situ keratomileusis or“LASIK”. In LASIK a surgeon first measures the optical properties of apatient's eye to determine the amount and type of correction necessaryto improve vision. This is best accomplished when the patient's pupil iscompletely dilated to its natural extent so that the greatest area ofthe patient's cornea can be measured for subsequent laser sculpting.Bright visible lighting interferes with this objective by causing thepatient's pupil to constrict from its natural maximum dark or nightvision diameter of approximately 8 millimeters to 1.5 millimeters orless, significantly limiting the area of the patient's cornea that canbe measured and subsequently resculpted.

Though it is possible to dilate a patient's pupil with pharmaceuticalcompounds such as tropicamide, pharmaceutical dilation often results inan unnatural pupilliary diameter that can be distorted or off center.This further complicates the ocular measurement process by introducinganother variable to the performing surgeon, potentially limiting controland impacting the outcome of the process. Additionally, tropicamideachieves dilation by temporarily paralyzing the muscles responsible forfocusing in the patient's eye. This paralysis usually lasts at least afew hours and therefore the patient cannot safely operate a motorizedvehicle to return home until the paralyzing effects of the chemicaldilators have completely subsided or been chemically reversed bycompounds such as dapiprazole.

Though it is possible to measure the optical functioning of a patient'seye in subdued light conditions in an effort to expand pupillarydilation without chemicals, it is not possible to perform the subsequentsurgical sculpting procedure on the patient's cornea in the absence ofvisible light without sacrificing control. As a result, there is asignificant need in the art for methods and apparatus that will enhancethe outcome of such delicate or meticulous visually directed procedures.

SUMMARY

These and other objects are achieved by the apparatus and methods of thepresent invention which, in a broad aspect, provide novel visualizationplatforms for performing enhanced visually directed procedures on targetobjects or tissues under low ambient lighting conditions. Thevisualization platforms of the present invention can be stand-aloneapparatus or retro-fit to existing optical systems such asstereomicroscopes. In a broad aspect the visualization platforms includeat least one high resolution photosensor which is capable of receivingand acquiring a plurality of optical views of the target object of theprocess in at least one wavelength outside of the wavelengths of normalvisible light. The high resolution photosensor then transmits aresultant real-time high resolution video signal which is received by atleast one high resolution video display that, because of the multiplehigh resolution optical views presented, can be viewed by the operatoror others as a real-time high definition three dimensional visual imagein spite of the absence of substantial amounts of ambient or directvisible light. These real-time high definition three dimensional visualimages include minute visual details as well as the real-time responsesof the target objects and tissues involved to the various steps of theprocesses even though the presence of visible light is markedly reducedor even essentially eliminated.

This significantly improves the comfort and stamina of the processoperator or surgeon as well as the comfort and compliance of a surgicalpatient while providing the operator or surgeon with enhanced visualcontrol of the process. Reduced or low ambient lighting in the visiblewavelengths makes the operating environment more comfortable by reducingthe heat associated with high output lighting. Removing the need forsuch lighting also frees up valuable process or operating room spacethat used to be devoted to lighting fixtures.

Of equal importance, reducing ambient visible lighting functions toreduce or remove phototoxicity and dyschromatopsia in surgical patients.Reduced ambient visible light also reduces reflected glare and highcontrast shadows that can confuse or overwhelm the vision of theoperator or surgeon, particularly when the operator or surgeon shiftshis focus away from the target object and back again. In the past, theoperator or surgeon would have to pause in order to allow his own eyesto adjust to the changes in lighting when he shifted his focus away fromthe microscope to the surrounding environment in order to adjustequipment or change tools. The present invention eliminates these pausesand delays while it facilitates the operator's or surgeon's ability toview the surrounding environment while maintaining acute visual controlof the target process.

“Visible light” is commonly understood to be light having wavelengthscorresponding to the visible or optical spectrum. Normally perceived aswhite in color, when refracted or bent through an optical prism visiblelight spreads out into differing wavelengths corresponding to thecharacteristic colors of the rainbow. Scientifically speaking, visiblelight is that portion of the electromagnetic spectrum having awavelength of about 380 nanometers (1 nanometer=1×10⁻⁹ m) to about 750nanometers where the normal human eye will respond to theelectromagnetic energy and perceive the presence of light. In terms offrequency, visible light corresponds to a frequency band in the vicinityof 400-790 terahertz. A light-adapted eye generally has its maximumsensitivity at around 555 nm (540 THz), in the green region at themiddle of the optical spectrum. The present visualization platform hasat least one high resolution photosensor which can detect at least onewavelength or frequency of light outside of this range.

Exemplary wavelengths within the scope and teachings of the presentinvention that are outside of the wavelengths of normal visible lightcan be longer or shorter than the visible light wavelengths and includeat least one longer wavelength of light that is between about 700nanometers and about 1400 nanometers and at least one wavelength oflight that is shorter than about 400 nanometers. As those skilled in theart will appreciate, such longer wavelengths are commonly referred to asinfrared or “IR” wavelengths, and are not visible to the eye; whereasshorter wavelengths are commonly referred to as ultraviolet or “UV”wavelengths.

Utilizing the teachings of the present invention the operator or surgeoncan inspect or measure a target object or tissue under light conditionshaving visible light present in amounts that are insufficient to causeheating or discomfort to the operator, surgeon, or patient, or damage tothe target object or tissue without sacrificing visual acuity orcontrol. Then, the operator or surgeon can perform a subsequentprocedure on the target object or tissue under light conditions that aresubstantially identical to the light conditions of the inspecting step.In this manner, the present invention improves the comfort and controlof the process operator or surgeon and directly enhances the outcome ofthe process by removing visual distractions, discomfort, and fatigue.

Target objects or tissues which are contemplated as being within thescope of the present invention include anything for which visualizationwith wavelengths of light outside of the wavelengths of visible lightwould be beneficial. These may include, without limitation,microelectronics and micromechanical articles and devices or otherprecision devices such as watches and the like. They also may include,without limitation, tissues within the human body such as the eyes,ears, nose, and throat, the brain, heart, vasculature, joints, tumors,or any other part of the human body.

An exemplary embodiment of the apparatus and methods of the presentinvention that is particularly well suited to illustrate its featuresand advantages is a visually directed procedure on an eye such as lasersurgery exemplified by LASIK corneal resculpting. Utilizing theteachings of the present invention a LASIK surgeon first inspects thepatient's eye under light conditions having insufficient visible lightto cause the patient's pupil to constrict substantially from its maximumpupillary diameter. Then the LASIK surgeon performs the cornealresculpting under substantially identical lighting conditions.

As those skilled in the art will appreciate, during the enhanced LASIKprocedure of the present invention, because the patient's eye does nothave to react to relatively bright visible light the patient's pupilremains dilated at or near its normal or natural maximum pupillarydiameter. This enables the ocular surgeon performing the procedure toachieve an enhanced outcome including improved overall corrections andimproved night vision because a more accurate and complete diagnosticwaveform can be measured for the target eye with a completely dilatednatural pupillary diameter.

Further, because the subsequent sculpting procedure is performed undersubstantially identical low visible light conditions to the initialinspecting or measuring step, the LASIK surgeon can better align andadjust the LASIK apparatus to an essentially identical and thereforefamiliar target while the apparatus and associated methods of thepresent invention provide the surgeon with a real-time, high resolutionthree dimensional video image of the target object or tissue derivedfrom the non-visible wavelengths which provides the surgeon with precisecontrol over the procedure.

Of equal importance, the patient is less likely to move or changeposition in response to bright lights because the procedures of thepresent invention are performed without bright visible lighting shiningdirectly into the patient's eye. This has the added benefit of makingthe patient both more comfortable and more stably compliant, furtherenhancing the procedure and its outcome by virtually eliminating subtletwitching and movement in response to the discomfort of bright ambientlighting. Similarly, the elimination of hot visible light lamps whichmay require a surgeon to wear visors to reduce glare enhances thecomfort and stamina of the LASIK surgeon during the procedure. Thus,when utilizing the apparatus and methods of the present invention, anoperator or surgeon may perform the enhanced procedures in greatercomfort for longer periods of time without sacrificing acute visualcontrol.

It also is within the scope and teachings of the present invention todigitally process the real-time high resolution video signal transmittedfrom the at least one high resolution photosensor to produce a highdefinition video display of the target object or tissue having aresolution of at least about 1280 lines×720 lines. Further, where thehigh resolution photosensor of the present invention is capable ofreceiving at least two optical views of the target object or tissue, itis within the scope of the present invention to present the visualsignal in high definition on a three dimensional (“3D”) video display.This greatly facilitates the operator's ability to perform theprocedures under low ambient light conditions at an enhanced levelrelative to prior art systems.

The three dimensional high definition views provided by the presentinvention can be presented on a relatively large conveniently locatedscreen without giving up the sense of depth and relative space needed toperform a meticulous or delicate procedure without the need forrelatively high levels of ambient lighting. The 3D visualizationprovided by the present invention also is a huge benefit for operatorsand surgeons learning how to operate or honing a new technique orprocedure. For example, a teaching physician can demonstrate a procedureto students in real-time 3D on a screen visible to those besides theoperating surgeon.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an illustration of an exemplary apparatus of the presentdescription retrofitted on a surgical microscope.

FIG. 2 is an illustration of an alternative exemplary apparatus of thepresent description retrofitted on a surgical microscope including anoptical eyepiece.

FIG. 3 is a schematic overview of an exemplary embodiment of anapparatus of the present description illustrating features thereof.

FIG. 4, is a plan view of an exemplary alignment control panel of thepresent description illustrating an exemplary embodiment of a user inputcontrol thereof.

DETAILED DESCRIPTION OF THE INVENTION

The present disclosure generally is related to apparatus and methods forvisualization. More particularly, the apparatus and methods of thepresent invention provide novel visualization platforms for performingenhanced visually directed procedures on target objects or tissues underlow ambient lighting conditions. The visualization platforms of thepresent invention can be configured to function as a stand-aloneapparatus or can be retro-fit to existing process control or monitoringoptical systems such as stereomicroscopes used in precisionmanufacturing and testing as well as in microsurgical techniques.

In a broad aspect the visualization platforms of the present inventioninclude at least one high resolution photosensor such as a camera orcharge coupled device which is capable of receiving and acquiring aplurality of optical views of the target object of the process in atleast one wavelength of light outside of the wavelengths of normalvisible light. Those skilled in the art will appreciate that receivinglight in visible wavelengths in addition to wavelengths outside of thewavelengths of normal visible light is also within the scope of thepresent invention. The high resolution photosensor then transmits aresultant real-time high resolution video signal which is received by atleast one high resolution video display. Because of the multiple highresolution optical views transmitted and presented on the display, theoperator of the visualization platform, or others, is able to view areal-time high definition three dimensional visual image of the targetobject or tissue provided by the present invention in spite of theabsence of substantial amounts of ambient or direct visible light.

In direct contrast to the prior art where reducing visible light reducesthe ability to view the process target, the real-time high definitionthree dimensional visual images of the present invention provide theprocess operator with precise views of minute visual details as well asthe real-time responses of the target objects and tissues involved tothe various steps of the processes. As a result, the process operator isable to manipulate and control the target object or tissues with a highdegree of precision even though the presence of visible light ismarkedly reduced or even essentially eliminated.

As an added benefit, by reducing or significantly lowering ambientlighting in the visible wavelengths the present invention makes theoperating environment for conducting the process more comfortable forthe process operator by reducing the heat associated with traditionalhigh output visible lighting. Removing the need for such lighting alsofrees up valuable process or operating room space that would normally beoccupied by lighting fixtures, associated power cords, and the like. Inaddition to simplifying and to significantly improving the comfort andstamina of the process operator or surgeon, where appropriate to thetarget object or tissue, reducing heat in the vicinity of the targetobject or tissue can avoid drying, bleaching, or otherwise damaging theprocess target.

The inventive apparatuses described herein can be embodied in a singledevice which can be retrofitted onto existing surgical equipment such assurgical microscopes or open surgery apparatus. This is highlyadvantageous as the retrofit embodiments can be added to existingsystems, allowing expensive equipment to simply be upgraded as opposedto purchasing an entirely new system. The exemplary apparatus caninclude various optical or electronic magnification systems includingstereomicroscopes or can function as open surgery apparatus utilizingcameras and overhead visualizations with or without magnification.

An exemplary real-time multidimensional visualization module suitablefor practicing the present methods incorporates the basic structuralcomponents of the Applicant's TrueVision Systems, Inc. real-time 3D HDvisualization systems described in the Applicant's co-pending U.S.applications: Ser. No. 11/256,497 entitled “Stereoscopic ImageAcquisition Device,” filed Oct. 21, 2005; Ser. No. 11/668,400, now U.S.Pat. No. 8,339,447, entitled “Stereoscopic Electronic MicroscopeWorkstation,” filed Jan. 29, 2007; Ser. No. 11/668,420, now U.S. Pat.No. 8,358,330, entitled “Stereoscopic Electronic MicroscopeWorkstation,” filed Jan. 29, 2007; and Ser. No. 11/739,042 entitled“Stereoscopic Display Cart and System,” filed Apr. 23, 2007; all ofwhich are fully incorporated herein by reference as if part of thisspecification.

Turning next to the Figures, FIG. 1 illustrates the functional portionof a surgical microscope 100 retrofitted with an exemplary visualizationplatform of the present invention for performing an enhanced visuallydirected procedure on a target object or tissue under low ambientvisible light and incorporating image capture module 102 which includesa multidimensional visualization module and an image processing unit,both housed within image capture module 102, and therefore, notdepicted. Image capture module 102 may be associated with one or moredisplays, for example, monitors or overhead displays. The exemplaryimage capture module of the present invention includes at least one highresolution photosensor capable of acquiring a plurality of optical viewsto capture still images, photographs or video images of a target in atleast one wavelength of light outside of the wavelengths of visiblelight and transmitting a resultant real-time high resolution videosignal to the at least one associated high resolution video display.

As those skilled in the art will appreciate, a photosensor is anelectromagnetic device that responds to light and produces or convertslight energy into an electrical signal which can be transmitted to areceiver for signal processing or other operations and ultimately readby an instrument or presented to an observer on a display. Image capturemodule 102 is mounted, integrated, or secured to surgical microscope 104in place of the microscope's binocular eyepiece. Although surgicalmicroscope 104 has been retrofitted with image capture module 102, itstill retains the use of conventional controls and features such as, butnot limited to, iris adjustment knob 106, first adjustment knob 108,second adjustment knob 110 and objective lens 112.

Turning next to FIG. 2, an alternative embodiment of the visualizationplatform of the present invention is shown with image capture module 102retrofitted onto second surgical microscope 201. Within this alternativeembodiment of the present invention image capture module 102 is coupledto first ocular port 202 on ocular bridge 204 of second surgicalmicroscope 201. Further illustrating the adaptability of the presentinvention to multiple configurations of microscopes and ancillaryequipment, ocular bridge 204 also couples video camera 206 to a secondocular port on the rear of microscope 201 and therefore not visible inFIG. 2 as well as binocular eyepiece 208 to third ocular port 210. Anoptional fourth ocular port 212 is available for coupling additionaleyepieces and cameras to surgical microscope 201 where desired. Thus,although surgical microscope 201 has been updated or even retrofittedwith image capture module 102, it retains the use of conventionalcontrols and features such as, but not limited to, iris adjustment knob214, first adjustment knob 216, second adjustment knob 218, illuminationcontrol knob 220 and can be operated in a manner that is familiar tothose of ordinary skill in the art.

Also shown in FIG. 2 is signal cable 222. In accordance with theteachings of the present invention, image capture module 102 can sendand receive information such as real-time high resolution video signalsor control inputs through signal cable 222 to a variety of additionalcomponents including at least one high resolution video display or oneor more recording devices. Those skilled in the art will appreciate thatsignal cable 222 is exemplary only and that alternative means fortransmitting real-time high resolution video signals or control inputsto and from image capture module 102 such as wireless transmitters arewithin the scope of the present invention.

A further understanding of the low ambient visible light visualizationplatform of the present invention is provided by the exemplary,non-limiting configuration of visualization platform componentsillustrated in FIG. 3. Visualization platform 300 includes image capturemodule 102, coupled to photosensor 304 by bi-directional link 306. Thoseskilled in the art will appreciate that bi-directional link 306 can beeliminated where image capture module 102 and photosensor 304 arephysically the same device. Image capture module 102 is in directcommunication with image processing unit 308 by first cable 310. Firstcable 310 can be a cable connecting to physically different devices or acable connecting two physically different components within the samedevice, or can be eliminated if image capture module 102 and imageprocessing unit 308 are physically the same device.

First cable 310 allows, in certain embodiments of the present invention,bi-directional communication between image capture module 102 and imageprocessing unit 308. Image processing unit 308 generates images andvideos that are visually presented to an observer on display 312. It iswithin the scope of the present description that display 312 includemultiple displays or display systems (e.g. projection displays). Anelectrical signal (e.g. video signal) is transmitted from imageprocessing unit 308 to display 312 by a second cable 314, which is anykind of electrical signal cable commonly known in the art. Imageprocessing unit 308 can be in direct communication with multidimensionalvisualization module 316, which can also send electrical signals todisplay 312 via second cable 314. In one embodiment, image capturemodule 102, image processing unit 308, and multidimensionalvisualization module 316 are all housed in a single device or arephysically one single device. Further, one or all of the components ofthe present invention can be manipulated by control panel 318 via cablenetwork 320. In alternative embodiments, control panel 318 is wirelessand uses radio signals to transmit control data or optical using fiberoptics and light to transmit control data.

“Display,” as used herein, can refer to any device capable of displayinga still or video image. Preferably, the displays of the presentdisclosure display high definition (HD) still images and video images orvideos which provide a surgeon with a greater level of detail than astandard definition (SD) signal. More preferably, the displays presentsuch HD stills and images in three dimensions (3D). Exemplary displaysinclude HD monitors, cathode ray tubes, projection screens, liquidcrystal displays, organic light emitting diode displays, plasma displaypanels, light emitting diodes, 3D equivalents thereof and the like. 3DHD holographic display systems are considered to be within the scope ofthe present disclosure. In one embodiment, display 312 is a projectioncart display system and incorporates the basic structural components ofthe Applicant's TrueVision Systems, Inc. stereoscopic image display cartdescribed in the Applicant's co-pending U.S. application: Ser. No.11/739,042, entitled “Stereoscopic Display Cart and System” filed Apr.23, 2007, which is fully incorporated herein by reference as if part ofthis specification.

The exemplary image processing units as illustrated in FIGS. 1, 2 and 3include a microprocessor or computer configured to process data sent aselectrical signals from image capture module 102 and to send theresulting processed information to display 312, which can include one ormore visual displays for observation by a physician, surgeon or asurgical team. Image processing unit 308 may include control panel 318having user operated controls that allow a surgeon to adjust thecharacteristics of the data from image capture module 102 such as thecolor, luminosity, contrast, brightness, or the like sent to thedisplay.

In one embodiment, image capture module 102 includes a photosensor, suchas a camera, capable of capturing a still image or video images,preferably in 3D and HD. It is within the teachings of the presentinvention that the photosensor is capable of responding to any or all ofthe wavelengths of light that form the electromagnetic spectrum.Alternatively, the photosensor may be sensitive to a more restrictedrange of wavelengths including at least one wavelength of light outsideof the wavelengths of visible light. “Visible light,” as used herein,refers to light having wavelengths corresponding to the visiblespectrum, which is that portion of the electromagnetic spectrum wherethe light has a wavelength ranging from about 380 nanometers (nm) toabout 750 nm.

More specifically, the one or more data processors are also in directcommunication with multidimensional visualization module 316 and/orimage capture module 102. In one embodiment, the data processor orprocessors are incorporated into multidimensional visualization module316. In another embodiment, at least one data processor is a stand aloneprocessor such as a workstation, personal data assistant or the like.

The exemplary one or more data processors are controlled by built-infirmware upgradeable software and at least one user control input, whichis in direct communication with the data processors. The at least oneuser control input can be in the form of a keyboard, mouse, joystick,touch screen device, remote control, voice activated device, voicecommand device, or the like.

FIG. 4 illustrates such an exemplary user control input, in the form ofcontrol panel 318. Control panel 318 includes multidirectionalnavigation pad 402 with user inputs allowing a controlling surgeon oroperator to move data vertically, horizontally or any combination of thetwo. Additionally, the depth of the data can be adjusted using depthrocker 404 of control panel 318 and the rotation can be adjusted usingrotation rocker 406 of control panel 318. Depth can be adjusted usingboth increase depth position 408 and decrease depth position 410 ofdepth rocker 404. Additionally, rotation can be adjusted using bothincrease rotation position 412 and decrease rotation position 414 ofrotation rocker 406. Other non-limiting adjustments that can be made tothe pre-operative image or to the real-time visualization includechanges in diameter, opacity, color, horizontal and vertical size, andthe like, as known in the art. It should be noted that in exemplarycontrol panel 318 an adjustment can be undone by the surgeon utilizing“back” button 416. Further, the entire process can be ended by thesurgeon by engaging “cancel” button 418. Further, once the surgeon issatisfied with the alignment of the data, the alignment is locked intoplace by engaging “ok” button 420.

Alternative control panel embodiments for the manipulation and alignmentof the pre-operative still image are contemplated as being within thescope and teachings of the present description. For example, a hand-helddevice such as a 3D mouse can be used as known in the art to directlyposition templates, images, and references within the real-timemultidimensional visualization. Such devices can be placed on a tabletopor held in mid-air while operating. In another embodiment, foot switchesor levers are used for these and similar purposes. Such alternativecontrol devices allow a surgeon to manipulate the pre-operative stillimage without taking his or her eyes off of the visualization of asurgical procedure, enhancing performance and safety.

In yet another alternative embodiment of the present invention, a voiceactivated control system is used in place of, or in conjunction with,control panel 318. Voice activation allows a surgeon to control themodification and alignment of the pre-operative still image as if he wastalking to an assistant or a member of the surgical team. As thoseskilled in the art will appreciate, voice activated controls typicallyrequire a microphone and, optionally, a second data processor orsoftware to interpret the oral voice commands. In yet a furtheralternative embodiment, the apparatus utilizes gesture commands tocontrol pre-operative image adjustments. Typically, as known in the art,the use of gesture commands involves an apparatus (not shown) having acamera to monitor and track the gestures of the controlling physicianand, optionally, a second data processor or software to interpret thecommands.

Visualization platform 300 can be used in a wide variety of medical andnon-medical settings. For example, visualization platform 300 can beused in a medical examination room. In such an environment, imagecapture module 102 utilizes photosensor 304 to capture pre-operativepatient data such as still images, preferably in HD. Photosensor 304 canbe coupled to any piece of medical equipment that is used in anexamination room setting wherein pre-operative data can be captured.Image capture module 102 directs this data to image processing unit 308.Image processing unit 308 processes the data received from image capturemodule 102 and presents it on display 312.

Alternatively, visualization platform 300 can be used in an operatingroom. There image capture module 102 utilizes photosensor 304 to capturea real-time visualization of at least a portion of the target surgicalfield, preferably in HD, and more preferably in HD 3D. Image capturemodule 102 directs this data to image processing unit 308 includingmultidimensional visualization module 316. Image processing unit 308including multidimensional visualization module 316 processes the datareceived from image capture module 102 and presents it on display 312 inreal-time.

In one exemplary embodiment, visualization module 300 is used in anoperating room and photosensor 304 is a surgical microscope. Forexample, image capture module 102 can be retrofitted to an existingsurgical microscope or provided as a unitary component of a newmicroscope. The use of a surgical microscope in combination withvisualization platform 300 allows a surgeon to comfortably visualize asurgical procedure on one or more displays instead of staring for hours,in many cases, though the eyepiece of a surgical microscope for theextent of a surgical procedure.

Visualization module 300 used in an examination room can be in directcommunication with a corresponding visualization platform 300 used inthe operating room. The two apparatus can be directly connected eitherwirelessly or by cable, or indirectly connected through an intermediarydevice such as a computer server. In some embodiments, the two sectionscan be separate systems, even in different physical locations. Data canbe transferred between the two systems by any means known to thoseskilled in the art such as an optical disc, a flash memory device, asolid state disk drive, a wired network connection, a wireless networkconnection or the like.

In medical or surgical processes the reduction of visible ambientlighting and the associated heat and complexity in the operating roomalso adds to the comfort of a surgical patient and enhances thecompliance of the patient with the needs of the surgeon. As a result,the present invention can simplify and shorten the medical procedure andimprove its outcome; all while providing the surgeon with enhancedvisual control of the process.

Further enhancing the operator's or surgeon's visual control of theprocess, by reducing ambient visible lighting the present inventionfunctions to reduce reflected glare and high contrast shadows in theprocess environment that can confuse or overwhelm the vision of theoperator or surgeon. In the past, the operator or surgeon would have toreposition equipment or personnel relative to the lighting source toprevent shadows, possibly compromising his vision of the process targetor his ability to perform a process step. Similarly, when the operatoror surgeon would have to shift his focus away from the target object andback again in order to adjust equipment or to change tools the changesin ambient lighting would require that he pause in order to allow hisown eyes to adjust to the changes in lighting. The present inventioneliminates these pauses and delays by reducing the visible contrast inambient lighting while it facilitates the operator's or surgeon'sability to view the surrounding environment under relatively consistentand comfortable lighting levels while maintaining accurate visualcontrol of the target process.

This is accomplished by the exemplary embodiments of the presentinvention which provide a visualization platform for performing anenhanced visually directed procedure on a target object or tissue underlow ambient visible light is provided. The visualization platformincludes at least one high resolution photosensor capable of acquiring aplurality of optical views of the target object in at least onewavelength outside of the wavelengths of visible light.

“Visible light” as used herein refers to light having wavelengthscorresponding to the visible or optical spectrum. It is that portion ofthe electromagnetic spectrum where the light has a wavelength rangingfrom about 380 nanometers to about 750 nanometers (nm). The familiarcolors of the rainbow include all of the colors that make up visible orwhite light; whereas a single wavelength produces a pure monochromaticcolor. For example, the color blue corresponds to wavelengths of 450-495nm and the color yellow corresponds to wavelengths of 570-590 nm. Atypical human eye will respond to wavelengths in air from about 380nanometers to about 750 nanometers. In terms of frequency, thesewavelengths correspond to a spectral band ranging from about 400-790terahertz (THz). A light-adapted human eye generally has its maximumsensitivity at around 555 nm (corresponding to a frequency of 540 THz),in the green region at the mid-range of the optical spectrum.

The exemplary visualization platform of the present invention includesat least one high resolution photosensor which can detect at least onewavelength outside of this range. As those skilled in the art willappreciate, wavelengths of light outside of the wavelengths of normalvisible light can be shorter than or longer than the wavelengths ofvisible light. Exemplary wavelengths that are outside of the wavelengthsof normal visible light within the scope of the present inventioninclude at least one longer wavelength that is between about 700 nm andabout 1400 nm. Exemplary wavelengths that are outside of the wavelengthsof normal visible light within the scope of the present invention alsoinclude wavelengths of light that are shorter than the wavelengths ofvisible light. These include wavelengths in the ultraviolet range or“UV” range from about 400 nm or less.

More specifically, exemplary longer wavelengths can include wavelengthsbetween about 700 nm to about 1000 nm or 1 micrometer. As those skilledin the art also will appreciate, such longer than visible wavelengthsare commonly referred to as infrared or “IR” wavelengths and are notvisible to the eye. Infrared radiation is electromagnetic radiationtypically of a wavelength longer than that of visible light, but shorterthan that of microwaves. There are different regions in the infraredportion of the electromagnetic spectrum. Near-infrared corresponds tolight with a wavelength between about 700 nm to about 1400 nm. Shortinfrared corresponds to light with a wavelength between about 1.4micrometers (μm) to about 3 μm. Mid-wavelength infrared corresponds tolight with a wavelength between about 3 μm to about 8 μm.Long-wavelength infrared corresponds to light with a wavelength betweenabout 8 μm to about 15 μm. Far infrared corresponds to light with awavelength between about 15 μm to about 1 mm.

The exemplary visualization platform of the present invention includesat least one high resolution photosensor. A photosensor is anelectromagnetic sensor that responds to light and produces or convertsit to an electrical signal which can be transmitted to a receiver forsignal processing or other operations and ultimately read by aninstrument or an observer. It may be capable of responding to ordetecting any or all of the wavelengths of light that form theelectromagnetic spectrum. Alternatively, the photosensor may besensitive to a more restricted range of wavelengths including the atleast one wavelength of light outside of the wavelengths of visiblelight.

One broad example of a photosensor which the present visualizationplatforms can include is a camera. A camera is a device used to captureimages, either as still photographs or as sequences of moving images(movies or videos). A camera generally consists of an enclosed hollowwith an opening (aperture) at one end for light to enter, and arecording or viewing surface for capturing the light at the other end.The recording surface can be chemical, as with film, or electronic.Cameras can have a lens positioned in front of the camera's opening togather the incoming light and focus all or part of the image on therecording surface. The diameter of the aperture is often controlled by adiaphragm mechanism, but alternatively, where appropriate, cameras havea fixed-size aperture. Either configuration is contemplated as beingwithin the scope of the present invention.

Exemplary electronic photosensors in accordance with the teachings ofthe present invention include, but are not limited to, complementarymetal-oxide-semiconductor (CMOS) sensors or charge-coupled device (CCD)sensors. Both types of sensors perform the function of capturing lightand converting it into electrical signals. A CCD is an analog device.When light strikes the CCD it is held as a small electrical charge. Thecharges are converted to voltage one pixel at a time as they are readfrom the CCD. A CMOS chip is a type of active pixel sensor made usingthe CMOS semiconductor process. Electronic circuitry generally locatednext to each photosensor converts the received light energy into anelectrical voltage and additional circuitry then converts the voltage todigital data which can be transmitted or recorded.

The real-time high resolution video signal transmitted in the presentinvention can be a digital video signal which is a digitalrepresentation of discrete-time signals. Often times, digital signalsare derived from analog signals. By way of background, an analog signalis a datum that changes over time, such as the temperature at a givenlocation or the amplitude of the voltage at some node in a circuit. Itcan be represented as a mathematical function, with time as the freevariable (abscissa) and the signal itself as the dependent variable(ordinate). A discrete-time signal is a sampled version of an analogsignal where the value of the datum is noted at fixed intervals (forexample, every microsecond) rather than noted continuously. Where theindividual time values of the discrete-time signal, instead of beingmeasured precisely (which would require an infinite number of digits),are approximated to a certain precision—which, therefore, only requiresa specific number of digits—then the resultant data stream is termed a“digital” signal. The process of approximating the precise value withina fixed number of digits, or bits, is called quantization. Thus, adigital signal is a quantized discrete-time signal, which in turn is asampled analog signal. Digital signals can be represented as binarynumbers, so their precision of quantization is measured in bits.

With this understanding it will be appreciated by those of ordinaryskill in the art that by attaching the exemplary photosensor of thepresent invention to a visualization device such as a stereomicroscopewhich directs a plurality of views of a target object onto thephotosensor the present invention is able to acquire a plurality ofoptical views of a target object. Alternatively, it is contemplated asbeing within the scope of the present invention to utilize multiplephotosensors, each receiving light corresponding to a different view ofa target object and transmitting that information as a real-time highresolution video signal that can be recorded or presented for displayand viewing. In an exemplary embodiment of the present invention, thetransmitted digital video signal is capable of producing an image havinga resolution of at least about 1280 lines by 720 lines. This resolutioncorresponds to the typically minimum resolution for what one of ordinaryskill in the art would consider to be high definition or an HD signal.

The signals transmitted from the at least one photosensor are real-timehigh resolution video signals. “Real-time” as used herein generallyrefers to the updating of information at the same rate as data isreceived. More specifically, in the context of the present invention“real-time” means that the image data is acquired, processed, andtransmitted from the photosensor at a high enough data rate and a lowenough delay that when the data is displayed objects move smoothlywithout user-noticeable judder or latency. Typically, this occurs whennew images are acquired, processed, and transmitted at a rate of atleast about 30 frames per second (fps) and displayed at about 60 fps andwhen the combined processing of the video signal has no more than about1/30^(th) second of delay.

The transmitted video signal of the present invention resulting fromfocusing the visible or non-visible wavelengths of light onto the atleast one high resolution photosensor is a “high-resolution” videosignal having a resolution of at least 1024 lines by 728 lines. It isalso contemplated as being within the scope of the present invention forthe video signal to be a “high definition” signal. High-definition (HD)generally refers to a video signal having a higher resolution than astandard-definition (SD) video signal, most commonly at displayresolutions of 1280 by 720 lines (720 p) or 1920 by 1080 lines (1080 ior 1080 p).

When the high resolution video signal is received and presented on avideo display having corresponding high resolution or HD capabilitiesthe resultant image provides a degree of clarity, detail, and controlpreviously unattainable in the absence of high ambient visual light.Exemplary visual displays within the scope and teachings of the presentinvention include, without limitation, cathode ray tubes, projectionscreens, liquid crystal displays, organic light emitting diode displays,plasma display panels and light emitting diode displays.

Moreover, when the real-time high resolution video signal of the presentinvention includes multiple views of the target object or tissue thevideo display can be made three dimensional (“3D”) so that depth offield is presented to the process operator by presenting a differentimage of the target object or tissue to each eye in spite of therelative absence of ambient visible light. It is contemplated as beingwithin the scope and teachings of the present invention to utilize manytypes of high resolution 3D video displays including, withoutlimitation, stereoscopic 3D displays using polarized glasses much likethe visualization systems provided by the present inventors and marketedunder the name TrueVision Systems, Inc., which are the subject ofco-pending U.S. patent applications Ser. Nos. 11/256,497 filed Oct. 21,2005, Ser. No. 11/739,042 filed Apr. 23, 2007, Ser. No. 11/668,400 filedJan. 29, 2007, and Ser. No. 11/668,420 filed Jan. 29, 2007.Alternatively, autostereoscopic 3D displays that do not require the useof any special glasses or other head gear to direct different images toeach eye can be used. Similarly, holographic 3D displays are alsocontemplated as being within the scope of the present invention andreproduce a light field which is substantially identical to that whichemanated from the original target.

In a broader aspect, target objects and tissues which are contemplatedfor use in conjunction with the present invention include anything forwhich visualization with wavelengths of light outside of wavelengths ofvisible light would be beneficial. These include, without limitation,microelectronics and micromechanical articles and devices or otherprecision devices such as watches, jewelry, and the like. They also mayinclude, without limitation, tissues within the human body such as theeyes, ears, nose, and throat, the brain, heart, nerves, vasculature,joints, tumors, or any other part of the human body.

A further understanding of the features and benefits of thevisualization platforms and associated methods of the present inventionwill be provided to those of ordinary skill in the art in the followingnon-limiting context of an exemplary medical procedure where the targetobject or tissue is the human eye or part of the human eye and theenhanced visually directed procedure is laser surgery. As used herein,laser surgery generally refers to any surgical procedure which uses alaser. For example, laser surgery may refer to the use of a laserscalpel to cut or remove tissue.

In ophthalmology a particular type of laser known as an excimer laser isused to change the shape of the cornea in procedures known as LASIK andLASEK, which is an acronym for “Laser Assisted In Situ Keratomileusis”(LASIK) and “Laser Assisted Sub-Epithelial Keratectomy” (LASEK). Theseprocedures are intended to correct a patient's vision by reshaping thecornea to compensate for refractive errors and aberrations, therebyreducing the patient's dependency on glasses or contact lenses. LASEKpermanently changes the shape of the anterior central cornea using anexcimer laser to ablate (remove by vaporization) a small amount oftissue from the corneal stroma at the front of the eye, just under thecorneal epithelium. The outer layer of the cornea is removed prior tothe ablation. LASEK is distinct from LASIK which is a form of laser eyesurgery where a permanent flap is created in the deeper layers of thecornea prior to vaporization and resculpting the contours of the cornea.

Though the present invention is equally applicable to either type ofsurgery, for purposes of explanation and not of limitation the exemplaryembodiments will be discussed in the context of LASIK surgery. LASIK isfast becoming a common procedure performed by ophthalmologists forcorrecting myopia, hyperopia, and astigmatism. The first step in theLASIK procedure is to immobilize the target eye of the patient so that aflap of corneal tissue can be created to preserve the delicate outerlayer of the cornea while exposing the underlying layers. Typically, acorneal suction ring is applied to the eye, holding the eye in place.Once the eye is immobilized, a flap is created either with a mechanicalmicrokeratome slicing a thin layer of the outer cornea using a metalblade, or with a femtosecond laser microkeratome that creates a seriesof tiny closely spaced bubbles within the cornea underneath the outercorneal layer. With either flap forming technique a hinge of uncuttissue is left at one end of the flap. In either technique, great caremust be taken to avoid damaging the outer layer of the cornea and theprocedure is typically carried out under bright ambient lighting so thatthe surgeon can control the process.

Next, the flap is folded back to expose the middle layers of the corneaknown as the stroma. Then a pulsed excimer laser is used to remodel thecorneal stroma by vaporizing corneal tissue in a finely controlledmanner without damaging adjacent tissue because the laser is preciselycontrolled and no heat or burning is required to ablate the tissue. Thelayers of stromal tissue removed are extremely thin, only tens ofmicrometers thick. After the stromal layer has been resculpted orreshaped with the laser the flap is carefully folded back andrepositioned over the treatment area by the surgeon and checked toverify the absence of air bubbles or debris and to verify a proper fiton the eye. No sutures are needed to fix the flap in place as it remainsin position by natural adhesion until healing is completed.

The amount of stromal tissue ablated and the contour of cornealresculpting is determined by measuring the unaided eye's ability torefract light prior to the procedure. At present, the most accuratemethod for doing so is to determine a “waveform” representing how lightpasses through the interior volume of the eye. This non-invasiveprocedure identifies focusing errors and other abnormalities that theLASIK procedure can correct by removing different amounts of stromaltissue at varying locations about the optical axis of the cornea.Ideally, waveform measurements are made in a darkened room so that thepatient's pupil will dilate and thereby allow a greater area of thecornea to be exposed for ocular measurement. For example, a pupil thatis constricted under bright visible light may only allow measurementrelative to a circular area of the cornea approximately 1.5 mm indiameter whereas a dilated pupil may allow measurement of a circulararea closer to 8 to 10 mm in diameter.

However, prior to the present invention having a more complete andaccurate waveform was of little use because the LASIK procedure itselfwas performed under bright visible lighting which caused the patient'spupil to constrict. Because pupils are not perfectly centered and mayconstrict asymmetrically this made it difficult for the LASIK surgeon toalign the LASIK apparatus with a pupil that no longer resembled thepupil of the waveform measurement. As a result, an annular ring ofcorneal surface outside of the diameter of the constricted pupil wasdifficult to recontour effectively. The resultant LASIK procedure wasstill effective at correcting the patient's vision, but at night or indark environments where the patient's pupil would dilate the patientmight experience less than ideal vision as light passed through newlyexposed areas of the cornea that were not able to be resculpted due tothe pupillary constriction experienced under the bright lightingconditions of traditional LASIK procedures.

Utilizing the teachings of the present invention a LASIK surgeon is ableto overcome these drawbacks and to more completely resculpt the corneain response to the entire ocular waveform measurement in order toachieve enhanced visual improvements and improved night vision as well.This is accomplished by first inspecting the eye of the patient underlight conditions having visible light present in amounts that areinsufficient to cause the pupil of the patient's eye to constrictsubstantially from its maximum pupillary diameter; in other words, in adarkened room. Then, the LASIK procedure is performed under lightconditions that are substantially identical to the light conditions ofthis inspecting step so that the patient's pupil will dilate toessentially the same extent as it was during the inspecting andmeasuring step when the waveform was determined.

Performing the corneal resculpting in a darkened environment allows theLASIK surgeon to operate on an eye having familiar dimensions andappearance which facilitates his ability to align the LASIK apparatusand to more aggressively contour the outer corneal areas located moredistant from the optical axis of the patient's eye. Without the benefitof the present invention performing such an enhanced visually directedprocedure under low ambient visible light conditions would beessentially impossible because the surgeon would be unable to see andcontrol what was going on with the process. However, utilizing theteachings of the present invention the surgeon is able to “dial down”the ambient visible lighting without sacrificing precise visual controlbecause the present invention utilizes one or more wavelengths of lightthat are outside of the wavelengths of normal visible light to transmita resultant real-time high resolution video signal to a convenientlypositioned high resolution 3D visual display presenting the details ofthe process to the surgeon in exquisite detail with a realistic depth offield.

Moreover, the present invention makes the process more comfortable forboth the surgeon and the patient by substantially eliminating harshbright lighting and the associated heat and complexity in the processenvironment. As a result, the LASIK operator is better able to use hisown vision without having to pause or adjust to differing levels ofbrightness which both simplifies and expedites the process withoutsacrificing quality or control. Similarly, under the low ambient visiblelight conditions of the present invention the more comfortable patientis less likely to move or twitch as might happen in response to thebright visible lighting of conventional processes, further improving theperformance of the procedure and enhancing its outcome.

As those skilled in the art will appreciate, these benefits andadvantages of the present invention are equally applicable to a widevariety of processes and procedures beyond LASIK. For example, manyocular procedures involve accessing tissues within the ocular volumesuch as the retina or ocular lens capsules. Because the presentinvention provides apparatus and methods for conducting these proceduresunder low ambient light conditions it provides enhanced access to suchtissues within the eye by dilating the patient's pupil to a near maximumextent without sacrificing visual control of the process or withoutsacrificing open pupillary access to internal eye tissues in exchangefor illuminating those tissues with sufficient light to make themvisible to operate on.

Accordingly, the present invention is useful in a wide variety ofmedical and surgical procedures where both doctor comfort and patientcomfort are important and where enhanced control is beneficial.Exemplary procedures include, without limitation, treatment of tissueswithin the human body such as the eyes, ears, nose, and throat, thebrain, heart, vasculature, joints, tumors, or any other part of thehuman body.

Similarly, the present invention has direct applicability outside of themedical profession. For example, precision manufacturing or inspectionprocesses requiring precise degrees of control and visualization alsobenefit from the improved comfort the present invention provides to theprocess environment in conjunction with the enhanced visual acuity andcontrol of the inventive methods and apparatus. Microelectronictechnicians and the like can work longer periods of time with improvedlevels of concentration and performance when they are provided with theenhanced visual capacities of the present invention in conjunction witha more comfortable working environment that is free from excessive heat,glare, and shadows.

Prior to the present invention, most doctors and precision techniciansutilized stereomicroscopes to view their target objects, tissues, andwork pieces. This required them to look through the binocular eyepiecesof their microscopes for hours on end. The present inventionvisualization platforms and associated methods take the place of themicroscope eyepieces either directly or as a retro-fit and feedreal-time high definition digital video data to 3D displays orprojectors which can be conveniently mounted on a workstation or a cart.Unlike microscopes, because the display can be viewed by more than oneperson at a time, the present invention is very useful for teaching.

Unless otherwise indicated, all numbers expressing quantities ofingredients, properties such as molecular weight, reaction conditions,and so forth used in the specification and claims are to be understoodas being modified in all instances by the term “about.” Accordingly,unless indicated to the contrary, the numerical parameters set forth inthe specification and attached claims are approximations that may varydepending upon the desired properties sought to be obtained by thepresent invention. At the very least, and not as an attempt to limit theapplication of the doctrine of equivalents to the scope of the claims,each numerical parameter should at least be construed in light of thenumber of reported significant digits and by applying ordinary roundingtechniques. Notwithstanding that the numerical ranges and parameterssetting forth the broad scope of the invention are approximations, thenumerical values set forth in the specific examples are reported asprecisely as possible. Any numerical value, however, inherently containscertain errors necessarily resulting from the standard deviation foundin their respective testing measurements.

The terms “a,” “an,” “the” and similar referents used in the context ofdescribing the invention (especially in the context of the followingclaims) are to be construed to cover both the singular and the plural,unless otherwise indicated herein or clearly contradicted by context.Recitation of ranges of values herein is merely intended to serve as ashorthand method of referring individually to each separate valuefalling within the range. Unless otherwise indicated herein, eachindividual value is incorporated into the specification as if it wereindividually recited herein. All methods described herein can beperformed in any suitable order unless otherwise indicated herein orotherwise clearly contradicted by context. The use of any and allexamples, or exemplary language (e.g., “such as”) provided herein isintended merely to better illuminate the invention and does not pose alimitation on the scope of the invention otherwise claimed. No languagein the specification should be construed as indicating any non-claimedelement essential to the practice of the invention.

Groupings of alternative elements or embodiments of the inventiondisclosed herein are not to be construed as limitations. Each groupmember may be referred to and claimed individually or in any combinationwith other members of the group or other elements found herein. It isanticipated that one or more members of a group may be included in, ordeleted from, a group for reasons of convenience and/or patentability.When any such inclusion or deletion occurs, the specification is deemedto contain the group as modified thus fulfilling the written descriptionof all Markush groups used in the appended claims.

Certain embodiments of this invention are described herein, includingthe best mode known to the inventors for carrying out the invention. Ofcourse, variations on these described embodiments will become apparentto those of ordinary skill in the art upon reading the foregoingdescription. The inventors expect skilled artisans to employ suchvariations as appropriate, and the inventors intend for the invention tobe practiced otherwise than specifically described herein. Accordingly,this invention includes all modifications and equivalents of the subjectmatter recited in the claims appended hereto as permitted by applicablelaw. Moreover, any combination of the above-described elements in allpossible variations thereof is encompassed by the invention unlessotherwise indicated herein or otherwise clearly contradicted by context.

Furthermore, numerous references have been made to patents and printedpublications throughout this specification. Each of the above-citedreferences and printed publications are individually incorporated hereinby reference in their entirety.

In closing, it is to be understood that the embodiments of the inventiondisclosed herein are illustrative of the principles of the presentinvention. Other modifications that may be employed are within the scopeof the invention. Thus, by way of example, but not of limitation,alternative configurations of the present invention may be utilized inaccordance with the teachings herein. Accordingly, the present inventionis not limited to that precisely as shown and described.

The invention is claimed as follows:
 1. A method for performing anenhanced visually directed procedure under low ambient visible light ona patient's eye, the method comprising: instructing, via the processor,or causing an intensity of ambient visible light for imaging thepatient's eye to be low enough such that a pupil of the eye does notconstrict substantially from its maximum pupillary diameter, acquiring,from at least one high resolution photosensor, at least one firstreal-time high resolution video signal representing at least one view ofthe eye in at least one wavelength of light outside of the wavelengthsof visible light; acquiring, from the at least one high resolutionphotosensor or a different high resolution photosensor, at least onesecond real-time high resolution video signal representing the at leastone view of the eye in visible light; converting, via a processor, theat least one view corresponding to the at least one first real-time highresolution video signal at the at least one wavelength of light outsideof the wavelengths of visible light into at least one wavelength ofvisible light; combining, via the processor, the at least one wavelengthof visible light with the visible light of the least one secondreal-time high resolution video signal to form at least one thirdreal-time high resolution video signal; and displaying, via theprocessor, the at least one view corresponding to the at least one thirdreal-time high resolution video signal including the at least onewavelength of visible light, wherein the display of the at least onethird real-time high resolution video signal is brighter than a displayof the at least one second real-time high resolution video signal andenables the intensity of the ambient visible light to be low enough suchthat a pupil of the eye does not constrict substantially from itsmaximum pupillary diameter.
 2. The method of claim 1, furthercomprising: inspecting the eye of the patient; and performing an ocularprocedure on the eye.
 3. The method of claim 2, wherein the procedure islaser surgery.
 4. The method of claim 2, wherein the procedure is laserassisted in situ keratomileusis.
 5. The method of claim 2, whereininspecting includes determining a waveform for the eye.
 6. The method ofclaim 1, wherein the ambient visible light includes light having awavelength of about 700 nanometers to about 1400 nanometers.
 7. Themethod of claim 1, wherein the ambient visible light includes lighthaving a wavelength of about 700 nanometers to about 1 micrometer. 8.The method of claim 1, wherein the at least one third real-time highresolution video signal is displayed in high definition.
 9. The methodof claim 1, wherein the at least one third real-time high resolutionvideo signal represents at least two views of the eye, and wherein theviews are presented in high definition on a three dimensional videodisplay.
 10. A method for enhancing control of a visually directed eyeprocedure on a patient's eye having a pupil under low ambient visiblelight, the method comprising: instructing, via a processor, or causingan intensity of ambient visible light for imaging the patient's eye tobe low enough such that the pupil of the eye does not constrictsubstantially from its maximum pupillary diameter; acquiring, from atleast one high resolution photosensor, at least one first real-time highresolution video signal representing at least one view of the eye in atleast one wavelength of light outside of the wavelengths of visiblelight; acquiring, from the at least one high resolution photosensor or adifferent high resolution photosensor, at least one second real-timehigh resolution video signal representing the at least one view of theeye in visible light; converting, via a processor, at least one view ofthe eye in the at least one wavelength of light outside of thewavelengths of visible light into at least one wavelength of visiblelight; combining, via the processor, the at least one wavelength ofvisible light with the visible light of the least one second real-timehigh resolution video signal to form at least one third real-time highresolution video signal; displaying the at least one view correspondingto the at least one third real-time high resolution video signal in theat least one wavelength of visible light, wherein the display of the atleast one third real-time high resolution video signal is brighter thana display of the at least one second real-time high resolution videosignal; enabling an inspection the eye of the patient under lightconditions such that the intensity of the ambient visible light isinsufficient to cause the pupil of the eye to constrict substantiallyfrom its maximum pupillary diameter; and enabling a performance of anocular procedure on the eye under light conditions substantiallyidentical to the light conditions for inspecting the eye.
 11. The methodof claim 10, wherein the intensity of the ambient visible light isselected to reduce or remove at least one of phototoxicity ordyschromatopsia in the patient.
 12. The method of claim 10, wherein theintensity of the ambient visible light is selected to reduce at leastone of glare or high contrast shadows related to illuminating or imagingthe patient's eye.
 13. The method of claim 10, wherein the at least onehigh resolution photosensor includes a camera or a stereoscopic imageacquisition device.
 14. The method of claim 10, further comprisingpreventing visible light from a display from illuminating the patient'seye.
 15. The method of claim 10, wherein the ambient visible lightincludes light having a wavelength of about 700 nanometers to about 1400nanometers or light having a wavelength of about 700 nanometers to about1 micrometer.
 16. The method of claim 10, wherein the at least one thirdreal-time high resolution video signal is displayed at least one ofstereoscopically or in high definition.
 17. The method of claim 10,wherein the at least one third real-time high resolution video signalrepresents at least two views of the eye, and wherein the views arepresented in high definition on a three dimensional video display. 18.The method of claim 10, wherein the ocular procedure includes alaser-assisted in situ keratomileusis (“LASIK”) procedure.
 19. Themethod of claim 1, wherein the intensity of the ambient visible light isessentially eliminated.
 20. The method of claim 1, wherein causing theintensity of ambient visible light for imaging the patient's eye to below enough includes prompting a surgeon, via a video screen, to lowerthe intensity of ambient visible light.